The stage before the development of diabetes, with normal glucose tolerance but with an increased risk of developing diabetes at some future time. Examples of increased risk might include family history of diabetes, prior diagnosis of gestational diabetes, presence of a positive antibody test for diabetes, or insulin resistance.

HHS Secretary Tommy G. Thompson today warned Americans of the risks of "pre-diabetes," a condition affecting nearly 16 million Americans that sharply raises the risk for developing type 2 diabetes and increases the risk of heart disease by 50 percent.

HHS-supported research shows that most people with pre-diabetes will likely develop diabetes within a decade unless they make modest changes in their diet and level of physical activity, which can help them reduce their risks and avoid the debilitating disease.

"The good news is if you have pre-diabetes, you can do something about it," Secretary Thompson said. "We want people to know that pre-diabetes is a serious condition that can be reversed or alleviated with modest changes in their daily routines -- such as eating fewer calories and walking regularly for exercise."

Secretary Thompson and American Diabetes Association (ADA) President-Elect Dr. Francine Kaufman also unveiled an expert panel's new recommendations about pre-diabetes. The panel, convened by the ADA and HHS, calls for physicians to begin screening overweight people age 45 and older for pre-diabetes.

In addition, Secretary Thompson released an updated HHS estimate showing 17 million Americans suffer from diabetes -- an increase of 8 percent from the most commonly used previous estimate. The new estimate is based on population changes in the most recent U.S. census.

HHS and the ADA are using the new term "pre-diabetes" to describe an increasingly common condition in which blood glucose levels are higher than normal but not yet diabetic -- known in medicine as impaired glucose tolerance or impaired fasting glucose. Studies have shown that most people with this condition go on to develop type 2 diabetes within 10 years.

The panel -- which includes doctors and other diabetes experts, with representatives from HHS' National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and Centers for Disease Control and Prevention (CDC) -- stated that intervention in pre-diabetes is critical for three reasons. First, simply having blood glucose levels in the pre-diabetes range puts a person at a 50 percent greater likelihood of having a heart attack or stroke. Second, research shows that the development of type 2 diabetes can be delayed or prevented through modest lifestyle improvements. Third, for many people, modest lifestyle improvements can "turn back the clock" and return elevated blood glucose levels to the normal range.

"This new recommendation gives physicians added incentive to screen their middle-aged, overweight patients for both type 2 diabetes and pre-diabetes," Dr. Kaufman of the ADA said. "If you have pre-diabetes, you need to know it, so you can learn about the high risk of getting diabetes and the steps you can take to prevent it. If you already have diabetes, you need to be treated early to prevent complications."

The panel recommended that doctors screen overweight people age 45 and older for pre-diabetes during regular office visits using either one of the standard tests that detect diabetes: the fasting blood glucose test, which identifies impaired fasting glucose, or the oral glucose tolerance test, which identifies impaired glucose tolerance.

The panel also recommended that physicians consider screening adults younger than age 45 if they are significantly overweight and have one or more of the following risk factors:

• family history of diabetes
• low HDL cholesterol and high triglycerides
• high blood pressure
• history of gestational diabetes or gave birth to a baby weighing more than 9 pounds
• belong to a minority group (African-Americans, American Indians, Hispanic Americans/Latinos, and Asian American/ Pacific Islanders are at increased risk for type 2 diabetes.)

The expert panel did not recommend routine use of prescription drugs as initial treatment for people who have pre-diabetes. However, it did suggest that some people benefit from drug therapy, which may be considered when appropriate.

The recommendations resulted from the panel's analysis of several major studies that evaluated strategies to prevent type 2 diabetes, including HHS' Diabetes Prevention Program -- a major clinical trial involving more than 3,000 people that showed prevention efforts can be effective. The Diabetes Prevention Program found that diet and exercise resulting in a 5- to 7-percent weight loss lowered the incidence of type 2 diabetes by 58 percent. Participants lost weight by cutting fat and calories in their diet and by exercising (most chose walking) at least 30 minutes a day, 5 days a week.

"About 16 million people in the country have pre-diabetes and most of them don't know it," said panel member Dr. Judith Fradkin of NIDDK, which is part of HHS' National Institutes of Health (NIH). "Now that we have shown that we can prevent or delay diabetes, we need to find the people who can benefit. These new practical recommendations can help."

The panel's recommendations will be published in the ADA's Diabetes Care, a peer-reviewed journal of clinical research focused on the nation's fifth deadliest disease. The recommendations come as the incidence of obesity continues to rise despite growing evidence about its adverse effects on health and survival. In the United States, nearly 60 percent of adults are now considered significantly overweight, and in adolescents the prevalence of obesity has nearly tripled in the past 20 years.

As part of Secretary Thompson's announcement, HHS provided copies of ADA's diabetes risk-assessment tool, "Could You Have Diabetes and Not Know It?" to HHS workers. The questionnaire allows users to roughly assess their risks for diabetes quickly. Of the estimated 17 million people with diabetes in the U.S., about 5.9 million are undiagnosed.

Diabetes is a disorder of metabolism in which people have problems converting food to energy. It is the leading cause of adult blindness, kidney failure, and non-traumatic amputations, and a major cause of heart disease and stroke.

More information about research and recent advances related to diabetes is available at http://www.niddk.nih.gov or by calling NIDDK's National Diabetes Information Clearinghouse at 1-800-860-8747. Consumer information about diabetes is also available through the National Diabetes Education Program, an effort sponsored jointly by NIH and HHS' Centers for Disease Control and Prevention, and 200 public and private partners, at http://www.ndep.nih.gov/. Information about diabetes statistics and state programs is available at http://www.cdc.gov/diabetes or by calling 1-877-CDC-DIAB (1-877-232-3422).

More information about the ADA is available at http://www.diabetes.org or by calling 1-800-DIABETES (1-800-342-2383).

We also quote the ADA's webpage (at http://www.diabetes.org/main/info/pre-diabetes.jsp):

But research has also shown that if you take action to control your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing. The American Diabetes Association has just published a Position Statement on "The Prevention or Delay of Type 2 Diabetes" to help guide health care professionals in treating their patients with pre-diabetes...

The American Diabetes Association Risk Test for Diabetes can help you determine if you are at increased risk for diabetes or pre-diabetes. A high score may indicate that you have pre-diabetes or at risk for pre-diabetes. Take the test and find out for sure.

WHAT YOU CAN DO: Pre-diabetes is a serious medical condition that can be treated. The good news is that the recently completed Diabetes Prevention Program study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range.

While the DPP also showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes.

The American Diabetes Association is developing materials that will help people understand their risks for pre-diabetes and what they can do to halt the progression to diabetes and even to, "turn back the clock." In the meantime, ADA has a wealth of resources for people with diabetes or at risk for diabetes that can be of use to people interested in pre-diabetes.

FREQUENTLY ASKED QUESTIONS
What is pre-diabetes and how is it different from diabetes? A: Pre-diabetes is the state that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. About 11 percent of people with pre-diabetes in the Diabetes Prevention Program standard or control group developed type 2 diabetes each year during the average 3 years of follow-up. Other studies show that most people with pre-diabetes develop type 2 diabetes in 10 years.
Is pre-diabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose? A: Yes. Doctors sometimes refer to this state of elevated blood glucose levels as Impaired Glucose Tolerance or Impaired Fasting Glucose (IGT/IFG), depending on which test was used to detect it.
Why do we need to give it a new name? Has the condition changed? A: The condition has not changed, but what we know about it has. We are giving IGT/IFG a new name for several reasons. Pre-diabetes is a clearer way of explaining what it means to have higher than normal blood glucose levels. It means you are likely to develop diabetes and may already be experiencing the adverse health effects of this serious condition. People with pre-diabetes are at higher risk of cardiovascular disease. People with pre-diabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. People with diabetes have a 2- to 4-fold increased risk of cardiovascular disease. We now know that people with pre-diabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes.

Other questions that are answered at the ADA's webpage:

From an announcement sent to members of American Association of diabetes Educators:

"It is my pleasure to share with you some important news that has been released in Washington DC, regarding diabetes prevention. The American Diabetes Association took part in a press conference yesterday with Health and Human Services Secretary Tommy Thompson, Dr. Judy Fradkin of NIDDK, and Dr. Frank Vinicor of CDC. Three major pieces of news were released.

First, the HHS and ADA introduced a new term-"pre-diabetes"- to describe for the public the condition of having blood glucose levels higher than normal but not yet diabetes. This was done in order to help lay the groundwork for the translation of the new ADA/NIDDK Position Paper entitled "The Prevention or Delay of Type 2 Diabetes," which will appear in the April 2002 issue of Diabetes Care. For the public, pre-diabetes is a more friendly term than IGT/IFG. It also offers other advantages. We believe we can make pre-diabetes an empowering term, as in "Pre-diabetes is the time to prevent diabetes." Pre-diabetes also suggests a serious condition that should be addressed¯it is not a benign state; it should not be ignored.

Second, the HHS and ADA released specific recommendations on who should be screened for pre-diabetes, how they should be screened, and how often. Recommendations for treatment were also included.

Third, HHS released new diabetes statistics, updating prevalence and incidence figures. The new prevalence number is 17 million people with diabetes. And for the first time, the HHS fact sheet provides a number for adults who have "pre-diabetes"¯at least 16 million, as defined by IGT.

Members of the media learned that the diabetes community now recognizes that 33 million adults have blood glucose that is higher than normal-¯16 million in the pre-diabetic stage, 17 million with diabetes."

Anne Daly, MS, RD, BC-ADM, CDE
President, Health Care & Education
American Diabetes Association